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General NPI Number Information
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NPI Number | 1447391495
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Entity Type | Organization
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Legal Business Name | FAMILY AND CHILDREN BEHAVIORAL HEALTH PC
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Dates
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Enumeration Date | 02/11/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4656 W JEFFERSON BLVD STE. 135
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City | FORT WAYNE
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State | IN
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Zip | 46804-6857
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Country | US
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Telephone | 260-436-0959
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Fax | 260-436-0893
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Provider Business Mailing Address
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Address Line | 4656 W JEFFERSON BLVD STE. 135
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City | FORT WAYNE
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State | IN
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Zip | 46804-6857
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Country | US
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Telephone | 260-436-0959
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Fax | 260-436-0893
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SYED RASHID MUMTAZ
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Credential | M.D
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Telephone | 260-436-0950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 50004594A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 50004594A
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License Number State | IN
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